Childhood Chronic Conditions Research Articles

Does Diagnostic Certainty Matter?: Pain-Related Stigma in Adolescents with Juvenile Idiopathic Arthritis.

Childhood chronic pain conditions are common and vulnerable to stigma. Adolescents with chronic primary pain experience diagnostic uncertainty and describe pain-related stigma experiences across multiple social contexts. Juvenile idiopathic arthritis (JIA) is a childhood autoimmune, inflammatory condition with associated chronic pain, but with well-defined diagnostic criteria. The current study examined pain-related stigma experiences in adolescents with JIA. Four focus groups of 3-7 adolescents with JIA (N = 16), ages 12-17 (Mage = 15.42, SD = 1.82), and parents (N = 13) were conducted to examine experiences of, and reaction to, pain-related stigma. Patients were recruited from an outpatient pediatric rheumatology clinic. Focus group length ranged from 28 to 99 minutes long. Two coders used directed content analysis resulting in 82.17% inter-rater level of agreement. Adolescents with JIA described pain-related stigma experiences predominantly from school teachers and peers, and less from medical providers (e.g., school nurses), and family members after a diagnosis. The primary categories that emerged were (1) Felt Stigma, (2) Internalized Stigma, (3) Anticipatory Stigma/Concealment, and (4) Contributions to Pain-Related Stigma. A common experience of pain-related stigma was the perception by others that the adolescent was too young to have arthritis. In common with adolescents with unexplained chronic pain, our findings indicate that adolescents with JIA experience pain-related stigma in certain social contexts. Diagnostic certainty may contribute to greater support among medical providers and within families. Future research should investigate the impact of pain-related stigma across childhood pain conditions.

EMOTIONAL AND PROSOCIAL BEHAVIOURAL PROBLEMS AMONG SAUDI CHILDREN WITH ATOPIC DERMATITIS

Background: Atopic dermatitis (AD) is one of the most prevalent chronic conditions in children. It is a global public health concern because of its burden on the health systems. The disease is usually associated with comorbidities including psychosocial and behavioural problems. Objectives: To explore the emotional symptoms and peer relationship problems, hyperactivity/inattention, and prosocial behaviour among Saudi children with atopic dermatitis Methods: A cross-sectional study was conducted during November 2022 through an onlinesurvey using the short form of the Strengths and Difficulties Questionnaire. Parents of Saudi children from all over Saudi Arabia were recruited. Non-Saudi participants, subjects who refused to participate, and those with incomplete data were excluded. Results:During the past 12 months, 44.1% of children had eczema/skin allergy. Overall, 44.0% of atopic children had an abnormal Strengths and Difficulties Questionnairecategorization. The emotional problems subscale represent 36.0% while the prosocial subscales was 24.0%. Mental impairment was significantly associated with higher number of children in the family (p = 0.019), parental smoking (p = 0.038), as well as history of asthma (p = 0.004),deficit- hyperactivity disorder (p <0.001), and autism (p = 0.002). Conclusion:Our studysupports the existing literature on the presence of associations between AD and mental health disorders in children. High number of children in the family, parent smoking, history of asthma, attention deficit-hyperactivity disorder, and autism were predictors of mental health impairment. There is a need to screen patients for mental health impairment to ensure better outcome.

Mixed-Method Study of the Experiences and Routines of Caregivers of Children with Type 1 Diabetes

Background: Type 1 diabetes is one of the most prevalent chronic childhood conditions that affects family roles, routines, and the ability to participate in meaningful occupations after a child’s diagnosis. Because of the complex health management routines required to ensure the safety and well-being of a child with type 1 diabetes, caregivers may experience decreased overall health and well-being.

Epilepsy in childhood: an update on management

Background: The aim of this study was to review current database for the management of childhood epilepsy, presenting and comparing the different types of treatment, focusing[1] on the ones with the best efficacy. Original articles related to the subject were obtained from SciELO, PubMed and BVS database using descriptors from “Health Sciences Descriptors”. Results: Epilepsy is characterized as a neurological disease that occurs due to abnormal neuronal discharges in the cerebral cortex. It affects 0.5% to 1% of children and is the most frequent chronic neurologic condition in childhood. Anti-epileptic drugs (AEDs) are the most used treatment for epilepsy. Non farmacological options, such as epilepsy surgery and neurostimulation therapy can be used to treat refractory or drug-resistant seizures. Conclusions: Around 70% of individuals with active epilepsy can become seizure-free and go into long-term remission shortly after starting drug treatment with antiepileptic drug in monotherapy. Randomized controlled trials comparing surgery and combinations of AEDs suggest that surgery can be more effective in stopping seizures in children.
 
 
 

Evaluation of the predictive value of total IgE and absolute eosinophil levels on allergy test positivity.

Atopic diseases are the most common chronic conditions in childhood. The best treatment for allergic disease is possible with early diagnosis. The purpose of the study was to assess the predictive value of total immunoglobulin E (IgE) and eosinophil levels for allergy test positivity in patients diagnosed with asthma, allergic rhinitis (AR), atopic dermatitis (AD), and food allergy (FA). Pediatric patients between 0 and 18 years old diagnosed with asthma, AR, AD, and FA were included in the study. Demographic characteristics of the patients, total IgE, eosinophil (absolute and %) values, specific igE (SPIGE), and skin prick test (SPT) results were recorded. The data of 2665 patients were evaluated in the study. Of the patients, 58.6% were male, whereas 41.4% were female. The median age of the children was significantly higher both in SPT-positive and SPIGE-positive patients (p<0.001). If the criteria positivity is accepted as total IgE value is ≥104.5 (for AD: 86.5, asthma: 116.5, AR: 120.5, FA: 42.5) and absolute eosinophil ≥500 and/or eosinophil (%) ≥5%; test positivity was higher for each disease and all patients (p<0.001). Total IgE and eosinophil levels can be used to identify atopy in patients with symptoms of AD, asthma, and AR. Total IgE and eosinophil values are suitable and easily obtainable parameters for better evaluation of health-care resources for the diagnosis and follow-up of atopic illnesses.

Efficacy and safety of fexofenadine in children with allergic rhinitis

Allergic rhinitis is the most common undiagnosed chronic condition in children and negatively affects sleep, school performance and leisure activities. Intranasal corticosteroids and oral antihistamines are first-line treatments. The first generation of oral antihistamines is often used in children due to the cheaper costs, despite the high frequency of adverse events, like overall cognitive and psychomotor effects, which could increase the allergic rhinitis burden. A recent review by Meltzer et al. highlighted that second-generation antihistamines are effective and well tolerated in children with allergic rhinitis and are rated superior to first-generation antihistamines.

Secukinumab Therapy in Refractory Juvenile Idiopathic Arthritis.

Juvenile idiopathic arthritis (JIA), the most common chronic rheumatologic condition in childhood, remains a cause of significant morbidity, particularly in those with spondyloarthropathy, including psoriatic arthritis (PsA) and enthesitis-related arthritis (ERA). While secukinumab was recently approved for the treatment of children and adolescents with ERA and PsA, there is limited published data on its use in JIA, particularly in refractory cases, despite its efficacy in the treatment of adult arthritis. We aim to examine the use of this therapy in JIA in a single pediatric rheumatology center. A retrospective chart review was performed and 10 JIA patients who received treatment with secukinumab were identified. Data extracted included disease activity, patient demographics, comorbidities, medications, and laboratory data. Seven ERA, 2 PsA, and 1 poly JIA patient were treated with secukinumab at our center between April 2011 and July 2021. These patients had notably resistant disease, with a mean disease-modifying antirheumatic drug (DMARD) failure rate of 3.8. One hundred percent of patients who underwent magnetic resonance imaging (MRI) after being on at least 3 months of secukinumab therapy demonstrated improvement in their MRI findings. One patient developed a flare of uveitis while on secukinumab therapy, with no other adverse events recorded in our patients. Secukinumab therapy was recently approved for children and adolescents with ERA and PsA, and may offer an efficacious option given its demonstrated improvement in imaging and joint examination, as well as qualitative reports of pain, even in those who have failed other therapies. However, caution may be warranted in those with a history of uveitis and warrants further study.

Applying Lessons from the COVID-19 Pandemic to Improve Pediatric Asthma Care.

Asthma is the most common chronic childhood condition and is a risk factor for severe respiratory viral infections. Thus, early during the coronavirus disease 2019 (COVID-19) pandemic there was concern that children with asthma would be at risk for severe COVID-19 illness and that asthma control could worsen as a result of the pandemic. This article seeks to summarize what was learned in the early stages of the pandemic about the impact of COVID-19 on children with asthma. We review evidence from several studies that demonstrated a significant decline in asthma morbidity in the first year of the pandemic. Additionally, we describe several potential mechanisms that may explain the reduced frequency in childhood asthma exacerbations as well as review lessons learned for future management of childhood asthma. While the COVID-19 pandemic initially brought uncertainty, it soon became clear that the pandemic had several positive effects for children with asthma. Now we can apply the lessons that were learned during the pandemic to re-examine asthma care practices as well as advocate for best approaches for asthma management.

Trending now: modelling global epidemiology of type 1 diabetes in children and adolescents

Type 1 diabetes, one of the common chronic conditions in children and adolescents, is a serious lifelong condition requiring daily treatment with exogenous insulin for survival. Descriptive epidemiology is important for planning of adequate diabetes health-care provision and could provide clues to aetiology. Over the past few decades, standardised diabetes incidence registries have provided a wealth of data from selected countries.1,2 A recurring theme has been large geographical variation, increasing incidence rates, and lack of data from many low-income and middle-income countries (LMICs).

A randomized controlled trial evaluating the effectiveness of a self-management program for adolescents with a chronic condition: a study protocol

BackgroundSelf-management support is increasingly viewed as an integral part of chronic condition management in adolescence. It is well recognized that markers of chronic illness control deteriorate during adolescence. Due to the increasing prevalence of long-term chronic health conditions in childhood and improved survival rates of previously life-limiting conditions in children and adolescents, significant numbers of adolescents are having to manage their chronic condition effectively as they transition to adult health care. Therapy adherence has been identified as a major challenge for young people living with a chronic condition such as cystic fibrosis, diabetes, or asthma requiring long-term pharmacological therapy and/or lifestyle modifications. Most systematic reviews on self-management interventions address adult populations. Very few intervention studies are directed at adolescents with a chronic condition who are transitioning to adult health services. This protocol describes a prospective randomized controlled trial of a standardized self-management intervention program delivered to adolescents aged 15–18 years prior to their transfer to adult care. This study has been designed to provide evidence regarding self-management programs for adolescents and is the first study to use the Flinders Program with this important, under-researched age group.MethodsA randomized controlled trial is used to investigate the effectiveness of a modified adolescent-friendly version of an adult self-management program. This program is directed at improving self-management in an adolescent cohort 15–18 years of age with a chronic condition being treated in a specialist pediatric hospital. Participants will be randomized to either usual care or the modified Flinders Program plus usual care. Data collection will include measures of specific illness control, unscheduled hospital admissions, and questionnaires to record self-management competencies, quality of life, self-efficacy, and outcome measures specific to the chronic condition at baseline, 3 months, 6 months, and 12 months after delivery.DiscussionThis study will provide a better understanding of the elements required for effective self-management programs in adolescents with a chronic condition and address some important knowledge gaps in current literature. The study will be carried out in collaboration with the Discipline of Behavioural Health at Flinders University, Adelaide, Australia, in order to inform the development of an adolescent version of the successful and validated Flinders Program™.Trial registrationAustralian and New Zealand Clinical Trials Registry (ACTRN12621000390886). Registered on April 8, 2021.

Common chronic conditions in pediatric primary care

Chronic health conditions comprise illnesses as well as physical disabilities that last longer than 12 months and limit the patient’s usual activity. The prevalence of chronic illnesses and disabilities in children and adolescents has more than doubled in the last 60 to 70 years. Common chronic conditions encountered among children across the globe include bronchial asthma, cystic fibrosis, diabetes mellitus, epilepsy, and developmental disabilities like cerebral palsy, in addition to congenital and heredofamilial conditions including certain hemolytic anemias and genitourinary disorders endemic to Saudi Arabia and the Middle East. Factors implicated in the shift in child health epidemiology from acute to chronic illnesses include better availability of diagnostic tools, improved specialized care access for pediatric patients suffering from complex congenital disorders, neoplasms, and premature births, and especially in case of disadvantaged populations, environmental factors like unhealthy living conditions, food insecurity and poor perinatal health. The two most common chronic conditions of childhood and adolescence managed by primary care physicians around the world and in Saudi Arabia are asthma and diabetes. Common risk factors across various diseases are urbanization, poor lifestyle, and consanguinity. The research on childhood-onset diseases and their different phenotypes in Saudi Arabia is scarce and confined largely to a few highly prevalent conditions at present.

Boston Birth Cohort profile: rationale and study design.

In1998, the Boston Birth Cohort (BBC) was initiated at Boston Medical Center (BMC) in response to persistently high rates of preterm birth (PTB, defined as birth before 37 weeks of gestation) in the US population and the longstanding profound PTB disparity among Black, Indigenous, and people of color (BIPOC). The BBC encompasses two linked study protocols: The PTB Study serves as the baseline recruitment in the BBC. It aims to address fundamental questions about the causes and consequences of PTB. The study oversamples preterm babies using a case/control study design, in which cases are defined as mothers who deliver a preterm and/or low birthweight baby (<2500 grams regardless of gestational age). Controls are enrolled at a 2:1 control/case ratio and matched by maternal age (±5 years), self-reported race and ethnicity, and date of delivery (± 7 days for case delivery). From inception, it was designed as a comprehensive gene-environmental study of PTB. As a natural extension, the Children's Health Study, under a separate but linked Institutional Review Board protocol, is a longitudinal follow-up study of the participants who were recruited at birth in the PTB Study and who continue pediatric care at BMC. This linked model allows for investigation of early life origins of pediatric and chronic disease in a prospective cohort design. The BBC is one of the largest and longest National Institutes of Health-funded prospective birth cohort studies in the United States, consisting of 8733 mother-child dyads enrolled in the PTB Study at birth, and of those, 3592 children have been enrolled in the Children's Health Study, with a median follow-up of 14.5 years. The BBC mirrors the urban, underresourced, and underrepresented BIPOC population served by BMC. A high proportion of BBC children were born prematurely and had chronic health conditions (e.g., asthma, obesity, and elevated blood pressure) in childhood. The BBC's long-term goal has been to build a large, comprehensive database (epidemiological, clinical, and multiomics) and biospecimen repository to elucidate early life origins of pediatric and chronic diseases and identify modifiable upstream factors (e.g., psychosocial, environmental, and nutritional) to improve health across the life course for BIPOC mothers and children.

Translational research – Stress associated with parenting and caregiving of children with chronic conditions or special healthcare needs

The stress associated with parenting and caregiving is compounded when children and adolescents are diagnosed with chronic conditions or special healthcare needs. The broad nature of stress requires parents, families, and children to cope with the additional stress associated with the child's chronic condition or special healthcare needs, adapt to the child's ongoing care management, and focus on maintaining quality of life for their families. Further, parent caregivers experience stress and role change when confronted with the healthcare transition from pediatric to adult healthcare for their adolescent and young adult children with chronic conditions or special healthcare needs. Developing resilience through emotional support and living in supportive neighborhoods may facilitate coping by parents and their children. The role of nursing presence and parent peer support is integral to mitigating parental stress during adaptation to stressful situations associated with the child's healthcare.

Type 1 Diabetes Mellitus Comorbid with Malnutrition in Siblings

Background: Diabetes mellitus is a disorder of the metabolic homeostasis controlled by insulin, resulting in abnormalities of carbohydrate and lipid metabolism. Type 1 diabetes mellitus is one of the most common chronic conditions in children. This study aims to describe two cases of type 1 diabetes mellitus accompanied by malnutrition in children at Dr. M. Djamil General Hospital Padang.&#x0D; Case presentation: The case series describes two cases of diabetes mellitus type one with comorbid undernutrition. Both patients had a family history of diabetes mellitus. And their sibling died because of diabetes type 1. Grandmother and grandfather from the father's side had diabetes. The management of this disease consists of the management of type 1 diabetes mellitus and its complications and accompanying malnutrition.&#x0D; Conclusion: The management of type 1 diabetes mellitus includes the administration of insulin according to the monitoring of blood sugar levels and the management of comorbid diseases that accompany it. Education about the use of insulin and diabetes diet patterns is very important for parents and children with type 1 diabetes mellitus.

Maternal Schizophrenia and the Risk of a Childhood Chronic Condition.

Maternal schizophrenia heightens the risk for certain perinatal complications, yet it is not known to what degree future childhood chronic health conditions (Childhood-CC) might arise. This population-based cohort study using health administrative data from Ontario, Canada (1995-2018) compared 5066 children of mothers with schizophrenia to 25 324 children of mothers without schizophrenia, propensity-matched on birth-year, maternal age, parity, immigrant status, income, region of residence, and maternal medical and psychiatric conditions other than schizophrenia. Cox proportional hazard models generated hazard ratios (HR) and 95% confidence intervals (CI) for incident Childhood-CCs, and all-cause mortality, up to age 19 years. Six hundred and fifty-six children exposed to maternal schizophrenia developed a Childhood-CC (20.5/1000 person-years) vs. 2872 unexposed children (17.1/1000 person-years)-an HR of 1.18, 95% CI 1.08-1.28. Corresponding rates were 3.3 vs. 1.9/1000 person-years (1.77, 1.44-2.18) for mental health Childhood-CC, and 18.0 vs. 15.7/1000 person-years (1.13, 1.04-1.24) for non-mental health Childhood-CC. All-cause mortality rates were 1.2 vs. 0.8/1000 person-years (1.34, 0.96-1.89). Risk for children exposed to maternal schizophrenia was similar whether or not children were discharged to social service care. From age 1 year, risk was greater for children whose mothers were diagnosed with schizophrenia prior to pregnancy than for children whose mothers were diagnosed with schizophrenia postnatally. A child exposed to maternal schizophrenia is at elevated risk of chronic health conditions including mental and physical subtypes. Future research should examine what explains the increased risk particularly for physical health conditions, and what preventive and treatment efforts are needed for these children.

Household income and maternal education in early childhood and activity-limiting chronic health conditions in late childhood: findings from birth cohort studies from six countries

BackgroundWe examined absolute and relative relationships between household income and maternal education during early childhood (<5 years) with activity-limiting chronic health conditions (ALCHC) during later childhood in six longitudinal, prospective...

Childhood chronic condition and subsequent self-reported internalizing and externalizing problems in adolescence: a birth cohort study

Chronic conditions are common in childhood. We investigated the associations of childhood chronic conditions reported by parents with subsequent self-reported internalizing and externalizing problems in adolescence. A sample of 6290 children (3142 boys and 3148 girls) with data on chronic condition reported by parents both at 7 and at 16 years of age was obtained from the Northern Finland Birth Cohort 1986 (NFBC 1986), which is a longitudinal 1-year birth cohort (n = 9432) from an unselected, regionally defined population. Internalizing and externalizing problems were measured at 8 years of age with Rutter Children’s Behavioral Questionnaire by teachers and at 16 years of age with Youth Self-Report by adolescents. When studying the effects of history of chronic conditions on these problems at 16 years of age, childhood internalizing and externalizing problems and social relations were adjusted. A history of chronic condition predicted subsequent somatic complaints among all adolescents. Early-onset chronic conditions were related to subsequent externalizing (OR 1.35; 1.02–1.79) and attention problems (OR 1.33; 1.01–1.75) and later onset of chronic conditions with internalizing (OR 1.49; 1.22–1.82) and thought problems (OR 1.50; 1.18–1.92). The effect was specific for sex and the type of chronic condition.Conclusion: Childhood chronic conditions predicted internalizing and externalizing problems in adolescence. To prevent poor mental health trajectories, children with chronic conditions during their growth to adolescence need early support and long-term monitoring.What is Known:• Childhood adversities increase the risk of mental disorders.• Internalizing and externalizing problems have been suggested for measuring childhood and adolescent psychopathologies.What is New:• Having a chronic condition (CC) before the age of 7 or later but before the age of 16 had different outcomes in adolescence. The early onset predicted externalizing problems, whereas the late onset predicted internalizing problems and thought problems in adolescence. The risk of somatic complaints was increased regardless of CC onset time. These findings can reflect more restricted ability to mental processing in the younger children.

Anxiety and Depressive Symptoms in Adolescents with Type 1 Diabetes

Anxiety and Depressive Symptoms in Adolescents with Type 1 Diabetes

Study protocol: assessing SleeP IN infants with early-onset atopic Dermatitis by Longitudinal Evaluation (The SPINDLE study)

BackgroundAtopic dermatitis (AD) is the most common chronic inflammatory skin condition in childhood. Most (50-60%) children with AD report sleep disturbance, which is secondary to itch, dry skin, inflammation, and abnormal circadian rhythm. Sleep is essential for brain development, learning, and growth. Sleep disruption in early life is associated with cognitive and psychological dysfunction in later life. The aim of this study is to describe in detail the sleep architecture of infants with early-onset atopic dermatitis (AD), compared to controls, by using EEG polysomnography, sleep actigraphy, and parental reporting.MethodsThis observational study will recruit six- to eight-month old infants with moderate to severe AD and age-matched control infants who do not have AD. At six-eight months diurnal sleep electroencephalography and polysomnography will be performed in our research center. Nocturnal sleep actigraphy will be performed at home for five consecutive nights at six-eight months and 12 months. Between six and 12 months, monthly questionnaires will capture data on quantitative sleep and parental sleep. Skin barrier and immune profiles will be captured at six-eight and 12 months. AD will be assessed using standardized severity assessment tools and treated according to protocol. A neurodevelopmental assessment will be performed at 18 months to assess cognition and behaviour. An estimated sample size of 50 participants in each group is required to power the primary outcome of disturbed macrostructure of sleep and secondary outcomes of disturbed microstructure of sleep, and disturbed parental sleep, assuming an attrition rate of 60%. Potential confounding factors which will be controlled for in the data analysis will include parental educational level, parental depression, feeding practice, and number of siblings.DiscussionThis study will provide a rich analysis of sleep in infants with AD in the first year of life using detailed electroencephalography, novel actigraphy techniques, and longitudinal parent-reported data. It may provide guidance on the optimal treatment of AD to prevent or reduce sleep disruption.Trial registrationclinicaltrials.govNCT05031754, retrospectively registered on September 2nd, 2021.

Childhood embedded: childhood abuse and chronic physical health conditions over a 10-year period.

Childhood abuse is linked to experiencing multiple chronic health problems in midlife adults. Research has seldom examined whether childhood abuse is associated with a greater number of chronic physical health issues over time. The current study was to examine the contributions of childhood abuse on the development of chronic health conditions over a 10-year period. Data were taken from the study of Midlife Development in the United States. Using three waves of data, 661 married adults were included in the analysis. Using hierarchical regression, we found that childhood abuse was uniquely associated with the development of a greater number of chronic physical health conditions over a 10-year period. Post-hoc analysis found that neither gender nor age moderated the associations. Findings of the study indicate that childhood abuse was uniquely associated with a greater number of chronic physical health conditions over a 10-year period. These findings suggest that abuse in childhood may speed up biological aging and erode adult's health over time leaving adults vulnerable to chronic health conditions. Prevention efforts should assess adults for childhood abuse and the impact of childhood abuse on adult health over time may be preventable or more manageable.